Chronotropic Incompetence and its Relation to Exercise Intolerance in Chronic Obstructive Pulmonary Disease
Chronotropic Incompetence and its Relation to Exercise Intolerance in Chronic Obstructive Pulmonary Disease
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DOI：
10.1016/j.amjms.2016.12.015
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发表时间：
2017-03-01
影响因子：
3.1
通讯作者：
Liu, Jin-ming
中科院分区：
文献类型：
--
作者：
Liu, Hai-jian;Guo, Jian;Liu, Jin-ming
背景：研究变时性功能不全(CI)与疾病严重程度的关系，探讨CI对慢性阻塞性肺疾病(COPD)患者运动能力的影响。材料与方法：对60例稳定期COPD患者和45例健康志愿者进行动脉血气分析、肺功能和心肺运动试验。CI用变时性反应指数(CRI=(峰值心率-静息心率)/(220岁-静息心率))定义。根据CRI将COPD患者分为变时性正常组(n=23)和CI组(n=37)。COPD患者的运动能力(峰值摄氧量占预测值的百分比、峰值VO2%pred)、峰值心率和CRI均显著低于对照组。然而，静息心率明显高于对照组。脑梗死组的FEV1%、Pred和运动耐量均明显低于常压组。CRI与FEV1%pred和峰VO2%pred显著相关。多元回归分析显示CRI和FEV1%pred是COPD患者运动能力的独立预测因子。CRI的临界值为0.74，其预测VO2峰值的特异度为94.1%。结论：CRI与COPD患者的病情严重程度相关。CI可能是反映COPD患者运动能力的重要参数。
Background: To study the relationship between chronotropic incompetence (CI) and disease severity and to assess the effect of CI on exercise capacity in patients with chronic obstructive pulmonary disease (COPD).Materials and Methods: Arterial blood gas analysis, pulmonary function test and cardiopulmonary exercise testing were conducted in 60 patients with stable COPD and 45 healthy volunteers. CI was defined using the chronotropic response index (CRI = (peak heart rate-resting heart rate) / (220-age-resting heart rate). Based on CRI, patients with COPD were divided into the normal chronotropic group (n = 23) and CI group (n = 37).Resuls: CI was present in 61.7% of the patients with COPD. Exercise capacity (peak oxygen uptake as percentage of predicted value, peak VO2%pred), peak heart rate and CRI were significantly lower in patients with COPD than in controls. However, resting heart rate was significantly higher than in controls. FEV1 %pred and exercise capacity were significantly decreased in the CI group when compared with those in the normotropic group. There was significant association between CRI with FEV1%pred and peak VO2%pred. Multivariate regression analysis showed that CRI and FEV1%pred were independent predictors of exercise capacity in patients with COPD. A cutoff of 0.74 for the CRI showed a specificity of 94.1% in predicting patients with a peak VO2%pred < 60%.Conclusions: CRI was associated with disease severity in patients with COPD. CI may be an important parameter to reflect exercise capacity in patients with COPD.